Chlamydia Screening for High Risk Populations

Background: Chlamydia is the most common sexually transmitted bacterial infection worldwide. Chlamydia trachomatis is a bacterium that is commonly asymptomatic but highly curable with antibiotics if treated early. Without treatment, chlamydia can cause pelvic inflammatory disease and uterine scarring for women, which can lead to infertility or ectopic pregnancies. It can also be a precursor for cervical cancer and endometriosis in women, and potentially transferred to offspring during childbirth. Opportunistic prescreening and screening in urgent care can increase appropriate diagnosis of chlamydia that potentially would be missed or incorrectly dismissed as solely a urinary tract infection. Purpose: To increase chlamydia prescreening and screening for females, ages 15-24, presenting to urgent care with urinary symptoms. Framework/EBP Model: The ACE Star Model was used as the foundation for this project. The model focuses heavily on having a consistent body of knowledge that supports change. Its purpose is to use translational science for implementation of best practice guidelines. Evidence-based Intervention(s)/Benchmark(s): United States Preventative Services Task Force and Centers for Disease Control recommends routine screening of chlamydia for females 15 to 24 years of age because this group is considered high-risk. Routine care is typically provided via primary care providers. However, when given the opportunity in urgent care, sexually transmitted infections should be included in differential diagnoses when assessing urinary signs and symptoms. Many patients in high-risk populations do not see their primary care providers on a routine basis. Prior to screening, four prescreening questions within the electronic medical record were used to determine if screening was appropriate. Sexual activity and past screening routines are addressed in these questions. Urine was collected for screening and final results took about three days. Results: Of the 79 patients eligible for prescreening, 40 patients were prescreened. Of the 40 patients prescreened, 21 patients were screened for chlamydia with a urine sample. Two of the 21 females screened had a positive chlamydia test. Implications for Clinical Practice: Routine and opportunistic screening of chlamydia is highly recommended for early treatment and prevention of further complications and transmission. Conclusions: Screening for chlamydia should be practiced during routine yearly exams in primary care. However, urgent care settings should also utilize dysuria and urinary frequency visits to assess for chlamydia that would have otherwise been undetected. The overall goal for this project is to increase general health and decrease chlamydia transmission rates and complications.